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FY 2013 HHS Tribal Consultation Report 

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

US Department of Health and Human Services 

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and 

Disease Registry (ATSDR) 

FY 2013 Tribal Consultation Report1

I. Highlights of Division Specific Accomplishments/Activities 

Consultation with Federally Recognized Tribes – CDC/ATSDR Tribal Consultation Policy 

On February 19, 2013, CDC/ATSDR sent the revised Tribal Consultation Policy to the chief, 

chairperson, governor, president, or equivalent elected or appointed tribal leader of each 

federally recognized tribe for a review and comment period. The initial comment period closed 

on March 15, 2013. After several requests for an extension, CDC/ATSDR reopened the comment 

period until May 20, 2013. Sixteen letters were received from tribes and Native-serving 

organizations providing comments on the revised Policy. CDC/ATSDR will respond to each 

individual tribe and organization that submitted a letter to address their comments. 

II. Division Specific Activities 

Tribal Public Health Capacity Building and Quality Improvement (OSTLTS/OD) 

Under this new five-year cooperative agreement, activities will focus on strengthening and 

improving the infrastructure and performance of tribal public health agencies and tribal health 

systems through capacity building and quality improvement. To reduce health concerns within 

AI/AN populations, Priority Area 1 awardees will develop disease interventions, strengthen and 

build organizational infrastructure, and cultivate community partnerships. The Priority Area 2 

awardee will conduct monitoring and evaluation for all Priority Area 1 awardees for quality 

improvement and disseminate lessons learned. Awardees include: Bad River Band of Lake 

Superior Tribe of Chippewa Indians; Inter-Tribal Council of Michigan; Pascua Yaqui Tribe; 

Kalispel Tribe of Indians; Toiyabe Indian Health Project; and Native American Cancer Research 

Corporation (Priority Area 2). Total funding – $587,274 

Tribal Public Health Workgroup (OSTLTS/OD) 

Under this new five-year cooperative agreement, the National Indian Health Board is funded to 

coordinate a tribal public health workgroup to provide subject matter expertise and advice to the 

Tribal Advisory Committee and CDC/ATSDR. Funding – $200,000 

Building Capacity of the Public Health System to Improve Population Health through 

National, Non-Profit Organizations (OSTLTS/OD) 

Under a new five-year cooperative agreement, the Association of American Indian Physicians 

(AAIP) will complete several capacity-building projects affecting AI/AN tribes and people. 

These initiatives include Native Specimens Policy Consultation; Compendium of EvidenceBased Intervention Success Stories from Indian Country; Data into Action Training – 101 for 

Tribes/Urban Indian Programs in How to Access and Utilize Available Data for Local Level 

 

1

 Note: An acronym list is provided at the end of this report. 
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FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

Public Health Action; Native Public Health Courses for Schools of Medicine; and Tribal Grant 

Writing Training – Enhancement, Evaluation, and Promotion.

Public Health Associate Program (PHAP) (OSTLTS/FSO)

PHAP, managed by OSTLTS, is designed to identify future public health professionals with 

undergraduate degrees and a passion for public service and public health. Throughout the twoyear program, associates will gain hands-on, frontline experience that will serve as a foundation 

for their public health careers. There are four PHAP associates currently serving in tribal (2) and 

tribal-serving organizations (2). Funding – No specific award

Public Health Law 101: National Indian Health Board Public Health Summit Presentation 

(OSTLTS/PHLP)

On June 18, 2013, PHLP presented on Public Health Law 101 and highlighted examples of tribal 

public health law relating to the 10 great public health achievements of the 20th century. PHLP 

also offered an overview of a tribal technical assistance request PHLP received on tribal hunting 

and fishing rights. Funding – No specific award

Tribal Specimens Policy Memo (OSTLTS/PHLP) 

PHLP received a technical assistance request to explore the legal landscape pertaining to the 

collection, use, storage, disposal, and return of tribal laboratory specimens to be used in the 

development of a CDC model policy on the issue. Funding – No specific award

Accreditation Support Initiative (OSTLTS/DPHPI)

Total funding – $102,400

 The Eastern Band of Cherokee completed two of three accreditation prerequisites: a 

first-ever tribal health assessment and an agency strategic plan. Funding – $22,500

 The Ponca Tribe of Nebraska received funding to develop a mechanism for TribalTrack 

communications; train content area experts to use TribalTrack with tribal health 

departments; complete outreach sessions and train 17 tribal health department 

representatives; and modify and deliver an assessment tool to capture tribal health 

department education needs. Funding – $39,900

 The InterTribal Council of Arizona, Inc. increased the accreditation readiness of tribal 

health departments in Arizona, Utah, and Nevada by providing a readiness and technical 

assistance needs assessment, an accreditation readiness workshop series, and a tribal 

stakeholders roundtable. Funding – $40,000

CDC/IHS AI/AN Health Analyses Collaborations (NCEZID/DHCPP)

Ongoing epidemiologic/analytical collaborative projects with IHS, Alaska Native Tribal Health 

Consortium (ANTHC), CDC Arctic Investigations Program, other agencies and CDC divisions 

to detect and describe disease burden and health disparities for overall and specific infectious 

diseases among the AI/AN population. Analyses provide information for developing prevention 

strategies, vaccination policies, and reducing health disparities related to infectious diseases. 

Findings increase awareness of specific infectious diseases and highlight disease, person, and 

geographic target areas to further investigate health disparities. For example, the identification of 

lower respiratory tract infections disparities among Alaska Native children led to more in-depth 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

respiratory studies and educational efforts to reduce disease among young children in Alaska.

Highlights of FY 2013 accomplishments include 

 Infectious Diseases: 1) Analyzed overall and specific infectious disease hospitalizations 

among the AI/AN infant population using IHS data to provide recent infectious disease 

hospitalization rates, high-risk diseases and high-risk areas to focus further study and 

prevention measures for the reduction of infectious diseases in the AI/AN population. 

The findings were presented at the International Meeting on Indigenous Child Health. 2) 

Analyzed overall and specific infectious disease hospitalizations among the Alaska 

Native population using IHS data. This analysis provides recent infectious disease 

hospitalization rates, high-risk diseases and high-risks areas to focus further study and 

prevention measures for the reduction of infectious diseases in Alaska Native

communities. The findings were presented at the International Congress on Circumpolar 

Health and are now published. 

 IHS/NDI Linkage Project: Committee member on the Project and investigator on studies 

analyzing deaths among AI/AN infants and infectious diseases among all AI/AN deaths. 

The studies used newly created death dataset with IHS AI/AN race-corrected data which 

allowed for more accurate calculation of death rates among AI/AN people. Health 

disparities were examined by comparing death rates for non-Hispanic AI/ANs with those 

for non-Hispanic whites. Studies on infectious diseases mortality and infant mortality 

were completed and accepted for publication; the infant mortality findings were 

presented at APHA. 

 Molluscum Contagiosum virus (MCV): Case/control study was previously analyzed to 

describe the epidemiology and risk factors that contribute to the high incidence of MCV 

among children in two specific AI/AN communities. This work will help target outreach 

and education activities with the long term goal of reducing disease incidence in these 

communities. A presentation of a description of MCV cases in the communities was 

previously given at the Native Health Research Conference. A paper was cleared and is 

ready for submission for publication. 

 Dog bite injuries and rabies: 1) Analysis of AI/AN hospitalizations and outpatient visits 

for dog bite injuries with focus on effect related to tick-borne diseases and rabies. Dog 

bites were found to be a significant public health threat among AI/AN children living in 

the Alaska, Southwest, and Northern Plains West regions, which indicate that enhanced 

animal control and education efforts should reduce dog bite injuries and emerging 

infectious diseases. A paper was published. 2) Analysis of the occurrence of rabies 

prophylaxis in the Navajo Nation was conducted. The analysis also included dog and cat 

bites, cat scratches, and exposure to rabies virus. Findings to be written for publication.

 Encephalitis: A study of encephalitis-associated hospitalizations was conducted to 

describe the trend and occurrence of specified and unspecified encephalitis. The paper 

describing the findings has been submitted for publication. 

 Neurologic Diseases: 1) Ongoing analysis of mortality data for AI/ANs with prion 

disease as a cause of death. Current available data is used to determine the occurrence of 

the disease among this population, including in chronic wasting disease endemic areas for 

presentation at Prion conference. 2) Analysis of ALS-associated IHS inpatient and 

outpatient patient-based data to describe occurrence of ALS among AI/AN people. The 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

paper on ALS was published. 3) Analysis performed on the occurrence of Parkinson’s 

disease in the Navajo Nation, and a draft of the paper was completed for publication.

 Respiratory diseases: 1) Analyzed lower respiratory tract infection and RSV-associated 

hospitalizations among AI/AN children under 3 years of age to describe trends and highrisk areas for presentation and publication. 2) Participated in a study of non-cystic 

fibrosis chronic suppurative lung disease/bronchiectasis-related occurrence and risk 

factors among indigenous children in Australia, New Zealand, and Alaska. The first study 

paper was published and the second paper is prepared for clearance. 3) Conducted study 

of asthma-associated hospitalizations among AI/AN people to describe the recent 

occurrence of asthma among AI/AN children and identify high-risk groups. The paper is 

prepared for clearance. 4) Completed an analysis of influenza hospitalizations among 

AI/AN people to describe the occurrence during seasonal periods over time in 

comparison with a select US population. Analysis was completed, and a paper was 

submitted to clearance. 

 Varicella: Analysis of varicella-associated hospitalizations among AI/ANs was 

completed. The findings were presented at the International Meeting on Indigenous Child 

Health and published. 

 Vitamin D deficiency: Completed analysis of inpatient and outpatient visit data to 

examine the occurrence among AI/AN children. A case-control study to describe factors 

involved in AN children was completed. A draft of a paper for publication is prepared. 

 Diabetes: Assisted in a chart review analysis of diabetes-coded inpatient and outpatient 

visits in the AI/AN population. The findings were submitted in a paper for publication. 

 HPV/warts: Protocol developed for a collaborative study of HPV-associated 

hospitalizations among AI/AN people. Evaluation of NPIRS HPV-related immunization 

data is being conducted with CDC/IHS immunization staff. 

 STD adverse outcomes: Provided inpatient and outpatient visit analysis on select adverse 

events. A detailed study of ectopic pregnancies using these data was completed to 

examine the occurrence. The study was submitted as a paper for publication. Consultation 

and requests for specific IHS inpatient/outpatient visit analysis for specific diseases are 

conducted as appropriate. 

Total funding – No specific award

Arctic Investigations Program (AIP) (NCEZID/DPEI)

AIP’s program mission is the prevention of infectious disease in people of the Arctic and 

Subarctic, with particular emphasis on indigenous people’s health. AIP coordinates disease 

surveillance and operates one of only two Laboratory Response Network labs in Alaska. 

Highlights of FY 2013 accomplishments include 

 Sanitation services and infectious disease risk in rural Alaska: AIP assessed increased 

infectious disease risk due to lack of in-home sanitation services. These studies have been 

used to advocate for increased funding for water and sanitation services in Alaska.

 Response to emergence of replacement pneumococcal disease in Alaska Native infants:

AIP supported introduction of a new pneumococcal vaccine, PCV 13, in southwest 

Alaska. Usage results clarified that it provides protection for up to 75% of serious 

pneumococcal illnesses. Since routine use of this vaccine began in 2010, rates of serious 

pneumococcal infections have decreased in rural Alaska Native children. 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

 High rates of pediatric dental caries in Alaska Native children: Dental caries among 

Alaska Native children represent a substantial and long-standing health disparity. Results 

of an AIP investigation concluded that pediatric dental caries are approximately five

times more common in the region than for the general US childhood population. 

NCEZID’s Division of Preparedness and Emerging Infections, along with two Alaska 

Native tribal health organizations, conducted a cost-effectiveness study of caries 

prevention strategies. AIP is also evaluating a caries surveillance system using electronic 

health records in collaboration with a tribal health organization in southwest Alaska.

 Support for Alaska Native Health Research: AIP promotes research activities by tribal

health organizations and supports AI/AN health researchers. 

 Responding to pandemic H1N1 influenza in AI/AN populations: AIP has been addressing 

the increased influenza mortality among AI/AN people by leading a five-state 

investigation into risk factors for deaths. Risk factors include older age, prior medical 

conditions, delayed start of anti-viral medication, decreased access to care, and smoking. 

AI/AN race was not an independent risk factor for death. Among AI/AN persons the risk 

factors for death were pre-existing medical conditions, obesity, and smoking. A report is 

circulating among tribal groups and agencies for approval prior to submission for 

publication in 2014.

 Skin and soft tissue infections in rural Alaska: In 2012, the Yukon Kuskokwim Health 

Corporation, a tribal health organization in southwest Alaska, requested CDC assistance 

through an Epi-Aid mechanism to improve prevention and control of skin and soft tissue 

infections caused by methicillin-resistant Staphylococcus aureus. AIP responded with a 

three-week field investigation in the villages with the highest rates of infection. The 

results of a knowledge, attitudes, and behaviors survey are being used to develop pilot 

intervention for 2014. 

Total funding – No specific award

Partnerships for Prevention of Rocky Mountain Spotted Fever (RMSF) on Tribal Lands 

(NCEZID/DVBD)

RMSF is a serious and potentially fatal disease that emerged on Arizona tribal lands in the last 

decade, so far infecting more than 250 tribal residents, and causing the deaths of 20 since 2003. 

Epidemic transmission of RMSF is linked to the brown dog tick and free-roaming dog 

populations on Arizona reservations and some parts of northern Mexico. Preventing RMSF and 

ticks bites is an important goal for Arizona tribal communities, and understanding and preventing 

the spread of infection to new areas is an important goal for state and federal partners. During FY 

2013, the Rickettsial Zoonoses Branch (RZB) participated in an RMSF state partners planning 

meeting, held November 9th 2012 in Camp Verde, Arizona. Outcomes of the meeting included 

providing partner updates on progress toward RMSF control in the region, sharing new scientific 

findings related to RMSF, and the start of development of a framework for a state-wide model 

RMSF control plan. During 2013, RZB assisted with surveillance for RMSF on tribal lands by 

providing laboratory support to test canine blood specimens collected during some routine tribal 

rabies clinics for RMSF. Testing showed that several tribes (Colorado River Indian Tribes, Salt 

River Indian Community, Havasupai, Yavapai Apache) had little evidence of RMSF circulating 

among reservation dogs, but that another (San Carlos Apache Tribe) continued to have evidence 

of RMSF in dogs. RZB participated in monthly planning and data-sharing calls with three tribal 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

RMSF Task Forces (San Carlos Apache Tribe, White Mountain Apache Tribe, Tohono O’odham 

Nation). During 2013, RZB provided RMSF continuing medical education to healthcare 

providers serving Navajo Nation, and consulted on methods to improve tribal surveillance 

methods. The project is ongoing (started in 2003). Funding – $30,000 (including in-kind support)

The RMSF Rodeo: A Demonstration Prevention Project on the San Carlos Apache 

Reservation, 2012–2013 (NCEZID/DVBD, NCEH/DEEHS)

The RMSF Rodeo began in 2012 as a pilot tick prevention project with the San Carlos Apache 

Tribe. A collaborative project involving NCEZID, NCEH, tribal staff, the state of Arizona, 

USDA, and various private donors, the project aimed to improve human health and reduce 

human RMSF on the reservation by improving the health of community dogs. The project 

delivered appropriately timed and integrated pet care and tick control techniques to participating 

homes, including 1) placing a long-acting tick collar on all dogs; 2) treating every house in the 

project area once a month for four months with a tick-killing pesticide product; 3) creating a dog 

licensing and traditional collaring program to track dogs in the neighborhood; 4) providing free 

stakes and tethers to encourage owners to reduce pet dog roaming; 5) providing free spay or 

neuter services to promote dog population control. The first year of the project (2012) was highly 

successful and reduced tick infestations to < 1% of dogs, compared to 63% of dogs with ticks in 

non-project areas. In year 2 of the RMSF Rodeo project (2013), the project attempted sustained 

tick control using long-acting tick collars alone. Tick counts were sustained at low levels (< 3%) 

in the project community. As a result of this successful pilot, the San Carlos reservation 

expanded strategies of the RMSF Rodeo reservation wide in 2013, and achieved a 50% reduction 

in tick counts. In addition, two other tribes (White Mountain Apache and Tohono O’odham) are 

considering using strategies from the RMSF Rodeo during 2014. Funding – No specific award

Evaluating the Possible Effects of Doxycycline on Developing Teeth when Prescribed for 

Suspected RMSF (NCEZID/DVBD, NCCDPHP/DOH)

Doxycycline is recommended by both CDC and the American Academy of Pediatrics as the 

treatment of choice for suspected RMSF in patients of all age. Although older tetracyclines cause 

staining of adult teeth when administered to children under the age of eight, doxycycline is a 

newer antibiotic in this class and has not been shown to cause this effect. Despite lack of 

evidence, the current FDA warning label for doxycycline states that it should not be used in 

children under the age of eight years due to possible staining of developing permanent teeth. The 

current label likely contributes to increased mortality from rickettsial infections among pediatric 

patients by encouraging healthcare provider avoidance. Over two-thirds of US healthcare 

providers said they would not use doxycycline to treat suspected RMSF in kids younger than 

eight years old. The case fatality rate among US children aged zero to nine is six times higher 

than that for adults. On Fort Apache, RMSF is a significant public health issue, and suspected 

RMSF patients of all ages are routinely treated with doxycycline. The teeth of White Mountain 

children ages 8–16 years old who received doxycycline while less than eight years old and who 

now had permanent teeth erupted were examined during 2013; children were examined with a 

parent’s permission, and examinations were conducted by licensed dentists in school settings. No 

evidence of dental staining was observed in the permanent teeth of more than 75 children who 

had received doxycycline during the years of tooth development. Furthermore, there was no 

significant difference in tooth color between children who received doxycycline and those who 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

did not. These results may be used in future clinical education campaigns and to seek changes in 

the FDA label for doxycycline. Project is ongoing. Funding – No specific award

Capacity Building Assistance (CBA) to Improve the Delivery and Effectiveness of HIV 

Prevention Services for High-Risk and/or Racial/Ethnic Minority Populations 

(NCHHSTP/DHAP)

In FY 2013, 34 training sessions were provided by the three main CBA provider grantees who 

work with Native American populations, according to the Training Events Calendar (TEC). 

Because the TEC dataset is rather limited, and there is no variable available to indicate target 

population, the trainings by provided by these three providers have been selected as the most 

likely to represent trainings provided to Native American populations. These three CBA provider 

grantees are Colorado State University—Fort Collins CA7AE Project, Great Plains Tribal 

Chairmen’s Health Board, and National Native American AIDS Prevention Center.

Building Capacity of the Public Health System to Improve Population Health through 

National, Non-Profit Organizations (NCHHSTP/DSTDP)

Through the funding announcement “Building Capacity of the Public Health System,” which 

sought to ensure the provision of capacity building assistance for governmental and 

nongovernmental components of the public health system to optimize the quality and 

performance of public health systems, the public health workforce, public health data and 

information systems, public health practice and services, public health partnerships, and public 

health resources, CDC funded AAIP to support needs assessment and community engagement 

efforts to develop culturally competent, client-centered, and community-based interventions to 

prevent and control STDs among AI/AN populations in the US.

Improving HIV Surveillance Among AI/AN in the United States (NCHHSTP/DHAP)

The report entitled Improving HIV Surveillance Among American Indians/Alaska Natives in the 

United States (http://www.cdc.gov/hiv/pdf/policies_strategy_nhas_native_americans.pdf) was 

completed in January 2013. This report was produced by HIV Incidence and Case Surveillance 

Branch (HICSB) representatives with extensive (FY 2012) CDC-state (HIV surveillance shop) 

collaboration. The report was showcased at the HICSB Branch Meeting in June, 2013. 

Support for Lead Public Health Advisor (PHA) (NCHHSTP/DSTDP)

DSTDP continues to support STD/HIV prevention efforts of the Navajo Nation through the 

assignment of a lead PHA to the New Mexico Department of Health who serves as the 

designated STD/HIV technical advisor to the Navajo Division of Health. The lead PHA serves as 

a liaison between state, tribal, and local health programs and provides guidance and support 

epidemiological follow up, disease management, and program development and training.

Get Yourself Tested (GYT) Campaign at Tribal Colleges and Universities (TCUs) 

(NCHHSTP/DSTDP)

For the fourth consecutive year, DSTDP has partnered with IHS to promote the national GYT 

campaign across Indian Country. Since 2009, the effort across Indian Country has focused on 

strengthening relationships with TCUs in an effort to reach and educate Native young adults on 

TCU campuses. DSTDP staff reached out to 32 TCUs to share information and encourage 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

participation in the 2013 campaign and facilitate an evaluation of Native GYT efforts held during 

STD Awareness Month.

Support for Epi-Aid, Phoenix, Arizona (NCHHSTP/DSTDP)

DSTDP staff supported an Epi-Aid to investigate recent increases in gonorrhea among American 

Indians attending Phoenix Indian Medical Center (PIMC). Gonorrhea rates in Arizona have been 

increasing since 2010. Particularly large increases have been seen among American Indians, with 

a 150% increase in cases from 2010 (218 cases) to 2012 (538 cases). PIMC, a 127-bed hospital 

that serves Phoenix-area American Indians, reported a 96% increase in gonorrhea seen at their 

facility during the same period. CDC spent five days at PIMC gathering data to assist PIMC and 

the Arizona Department of Health in characterizing gonorrhea cases among American Indians 

attending PIMC from 2012 to 2013 with respect to demographics and geography, describing 

trends in gonorrhea case counts and evaluating the possible impact of PIMC interventions, 

characterizing PIMC gonorrhea screening practices in order to make recommendations for 

improved screening and detection, and determining whether case patients and partners were 

appropriately treated. Data analysis is ongoing. Funding – No specific award

Quality Improvement Project to Enhance HIV/STD/hepatitis C Screening among AI/AN 

(NCHHSTP/DSTDP)

DSTDP funding, awarded through a CDC/IHS interagency agreement, was provided to the 

Northwest Portland Area Indian Health Board (NPAIHB) to develop, implement, and assess a 

continuous quality improvement project to enhance HIV/STD/hepatitis C virus screening among 

AI/AN. The 12-month project partnered with four IHS and tribal health care facilities who 

focused on identifying, testing, and evaluating innovative practices to increase screening rates 

among AI/AN.

STD/HIV Prevention Training Center AI/AN Workgroup (NCHHSTP)

The STD/HIV Prevention Training Centers (PTCs), supported by CDC funding, have a longstanding AI/AN workgroup, currently co-chaired by staff at Denver PTC and California PTC. 

The workgroup continues to support numerous training and capacity building activities among 

tribes and tribal-serving organizations. 

Implementation of CHOICES in South Dakota (NCBDDD/DBDDD)

In 2010, CDC and IHS entered into a three-year interagency agreement to adapt and implement 

CHOICES, an intervention to prevent alcohol-exposed pregnancies, among non-pregnant women 

in American Indian communities. This project targeted settings serving American Indian women 

of reproductive age of the Oglala Sioux Tribe in South Dakota to determine the feasibility of 

implementing CHOICES in various IHS settings and the acceptability of the intervention by 

American Indian women. In 2013, the National Institute of Minority Health awarded a three-year 

cooperative agreement to Sanford Health to support broader implementation of CHOICES 

among American Indian women in South Dakota. Funding – $500,000 over 3 years

Disseminating CHOICES among Tribal Communities: A Partnership with the National 

Organization on Fetal Alcohol Syndrome and Tribal Serving Organizations (NOFAS) 

(NCBDDD/DBDDD)
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

In 2013, CDC worked with NOFAS to develop a plan to disseminate the CHOICES intervention 

broadly among settings serving tribal populations. During this year-long effort, NOFAS 

identified AI/AN stakeholders and received recommendations and feedback from them on topics 

pertinent to development of the plan (e.g., existing screening and brief intervention practices, 

implementation barriers/facilitators), as well as recommendations of individuals to serve in an 

advisory capacity to NOFAS. The final CHOICES Tribal Dissemination Plan resulting from this 

work was completed in December 2013. Funding – $100,000

Advancing Alcohol Screening and Brief Intervention in AI/AN Populations through 

Training and Technical Assistance (NCBDDD/DBDDD)

In 2013, CDC awarded two cooperative agreements to Denver Public Health and the University 

of Wisconsin to advance alcohol screening and brief intervention and CHOICES in AI/AN

populations through training and technical assistance. The purpose of these awards is to build 

capacity among the recipient organizations to serve as training and technical assistance centers 

on these two interventions in settings serving AI/AN populations. Each grantees will do this by 

initially working with three primary care clinics serving AI/AN populations. These awards are 

for a four year period. Funding – $275,000

Alaska Disability and Health Program (NCBDDD/DHDD)

Alaska Disability and Health Program is working with the Breast and Cervical Health Check 

Program to ensure that preventative screening efforts for Native Alaskans include 

acknowledgement of potential disability-related barriers and concerns. The Program’s 

understanding of Native Alaskan disability issues will be enhanced by a second round of needs 

assessment focus groups in rural/remote Alaska. Funding – $35,000

Montana Disability and Health Program (NCBDDD/DHDD)

The state of Montana is home to seven Indian reservations and 12 tribal groups. American 

Indians are Montana’s largest minority group with 7.5% of the population identifying as 

American Indian alone or in combination with another race. According to the Montana 2010 

Behavioral Risk Factor Surveillance System (BRFSS), 27.0% of adult American Indian 

population in Montana had a self-reported disability. At the start of the Montana Disability and 

Health Program in 2002, the Montana Department of Public Health and Human Services had 

established partnerships with Native American organizations (e.g., those operating on any of 

Montana’s seven Indian reservations) , including disability providers in the Developmental 

Disabilities, Vocational Rehabilitation, and Independent Living Services and Support Systems. 

Those partnership and outreach efforts have continued through FY 2012. The Montana Disability 

and Health Program has supported nutrition education and service delivery improvement through 

MENU-AIDDs at several residential services providers that work in Indian country (Blackfeet 

Opportunities) and others who have many tribal members as consumers (Mission Mountain 

Enterprises and Eastern Montana Industries). MENU-AIDDs is a health education curriculum 

that improves food systems and outcomes in group home serving adults with intellectual and 

developmental disabilities. Finally, accessibility ambassadors to improve access to community 

health centers and rural health clinics in FY 2012 have included clinics operating in partnership 

with IHS. Collaborating with Salish Kootenai College. Funding – $30,000
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

North Dakota Disability and Health Program (NCBDDD/DHDD)

The North Dakota Disability and Health Program is a collaboration among the North Dakota 

Center for Persons with Disabilities at Minot State University; the Center for Rural Health at the 

University of North Dakota; and the North Dakota State Health Department, Division of Chronic 

Disease, Office for the Elimination of Health Disparities. Tribal activities include a collaboration 

meeting with Amputee Coalition and the project’s tribal liaison, specific to the areas of limb loss 

and diabetes among North Dakota tribal communities. A workshop, Healthy Lifestyles for 

People with Disabilities, was held in the North Dakota tribal community Three Affiliated Tribes,

located on Fort Berthold Indian Reservation in New Town, North Dakota. Air time was 

purchased for running of project-produced diabetes/limb loss videos in waiting areas of Indian 

Health clinics in North Dakota reservation communities. A March 2012 meeting among project 

staff, Amputee Coalition staff, and tribal members was coordinated and facilitated by a project 

tribal liaison. Funding – $15,175

Limb Loss Public Health Practice and Information Resource Center (NCBDDD/DHDD)

Today, almost two million Americans have experienced amputations or were born with limb 

difference. Another 28 million people in the US are at risk for amputation. The Amputee 

Coalition is the nation’s leading organization on limb loss, dedicated to enhancing the quality of 

life for amputees and their families, improving patient care, and preventing limb loss. Over the 

last few years, the Amputee Coalition has developed a healthy partnership with the Plains 

Indians tribes in North Dakota by working with researchers at Minot State University and 

Okiciya Consulting, an American Indian- and woman-owned business. These efforts have led to 

the development of culturally appropriate peer support programs for the Plains Indians tribal 

community. Funding – $5,000

Paralysis Resource Center (PRC) (NCBDDD/DHDD)

PRC’s mission is to promote the health and well-being of people living with paralysis by 

providing comprehensive information, resources, and referral services. PRC’s Multicultural 

Outreach Program, located at the University of New Mexico through the PRC–UNM 

Cooperative Agreement, has expanded its activities on the Navajo Nation to target Native 

American communities throughout the US. The core elements of the Navajo Nation Project—a 

Navajo Nation Peer and Family Support Program and the dissemination of alternate-format 

materials on key public health topics for use by Community Health Representatives—continue. 

In the current project year, these activities will be expanded to other Native American 

communities through the national Community Health Representative Program of the IHS. 

Funding – $50,000 (through the Christopher and Diana Reeve Foundation)

Colorectal Cancer Control Program (CRCCP) (NCCDPHP/DCPC)

CRCCP’s goal is to increase colorectal cancer screening rates among men and women aged 50 

years and older from about 64% to 80% in funded states by 2014. Total funding – $2,347,431

 Alaska Native Tribal Health Consortium – The Alaska Tribal Health System’s CRC 

screening rate (flexible sigmoidoscopy in previous five years or colonoscopy in previous 

10 years) prior to the initiation of the CDC-funded CRCCP was 50.9% (GPRA, 2009) 

and has increased by 3.8% per year for a current screening rate of 58.5% (GRPA, 2012). 

In the regions partnering with the ANTHC CRCCP, GPRA data showed that screening 
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rates increased by an average of 73% since program initiation. BRFSS data (2011) 

showed that Alaska Native adults who had ever had a sigmoidoscopy or colonoscopy 

reached 68.1%, improving from 50% in 2010 and 51.8% in 2008. The 2011 rate is the 

first time that the Alaska Native rate has been above the rate for all Alaskans (65%) and 

Alaska whites (65%). ANTHC coordinated an Alaska Tribal Health System Scientific 

Roundtable on CRC Screening Recommendations to review and update clinical screening 

guidelines for Alaska Native people with 21 clinical representatives from seven tribal 

health organizations and the Mayo Clinic. The resulting guidelines will be published in a 

State Epi Bulletin. CRC efforts also include funding five tribal health organizations to 

implement evidence-based practices such as client reminders and providing technical 

assistance and guidance to non-funded tribal health organizations. The Program has 

provided 1,678 colonoscopies to low-income Alaska Native peoples. Funding – $700,000

 Arctic Slope Native Association – Through partnerships with the Alaska Cancer 

Registry, the Comprehensive Cancer Control programs, and the Alaska Breast and 

Cervical Health Partnership, the grantee works to increase CRC awareness among Alaska 

Natives living in the North Slope Borough. Arctic Slope Native Association supports 

systems-level changes to promote CRC screening, screening promotion events, and 

collaborates to provide a colorectal screening training opportunity for providers 

throughout the state of Alaska. The grantee also provides culturally appropriate patient 

navigation to the identified target population. Two hundred-and-twelve individuals have 

received colonoscopies through December 31, 2012. Funding – $377,431

 Southcentral Foundation (SCF) – SCF uses evidence-based strategies such as client 

and provider reminders to identify customer-owners eligible for colorectal cancer 

screening. The grantee has provided flexible sigmoidoscopy to 402 customer-owners as 

of December 2012 (the most recent date for which complete data are available). Funding 

– $670,000

 South Puget Intertribal Planning Agency – Funding – $600,000

Collaborative Partnerships in Cancer Prevention and Control for American Indians 

(NCCDPHP/DCPC)

The two primary activities of the cooperative agreement were: 1) Convene six regional meetings 

to strengthen relationships among cancer programs, with an emphasis on the inclusion of AI/AN

in state cancer control planning efforts. Attendees included CDC-funded state and tribal cancer 

programs; non-funded tribes and tribal organizations; non-governmental organizations; elders 

and community members; and universities. 2) Develop educational materials for the AI/AN 

population on breast, cervical, and colorectal cancer, and cancer survivorship. Develop 

educational materials for public health professionals to share best practices related to AI/AN 

cancer control and prevention efforts. Funding – $396,588

Summer Institute Course on Developing a Tribal Health Survey and Understanding the 

CDC BRFSS Survey in Your Community (NCCDPHP/DCPC)

DCPC, in collaboration with NPAIHB, developed a course on conducting tribal health surveys 

for NARCH’s Summer Institute training program. The course provided tribal public health 

managers and epidemiologists with concrete steps they can use in developing their own tribal 

health surveys. Epidemiologists involved with the NPAIHB and Albuquerque Area health survey 
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projects discussed with students how they designed, implemented, and analyzed their in-person 

survey or analyzed existing BRFSS data for specific tribes. DCPC helped students develop a 

draft health survey proposal and project plan for their tribe or Tribal Epidemiology Center 

through interactive sessions. Funding – No specific award

National Breast and Cervical Early Detection Program (NCCDPHP/DCPC)

Through the National Breast and Cervical Cancer Early Detection Program, CDC provides lowincome, uninsured, and underserved women access to timely breast and cervical cancer screening 

and diagnostic services. Total funding – $7,066,152

 Cherokee Nation (CN) – CN has a strong patient navigation component, with navigators 

embedded in each of the clinics to guide patients through screening and diagnostics 

services. Due to the effectiveness of the breast/cervical patient navigators, CN has 

expanded their patient navigation model over the last two years. Additional navigators 

were hired to serve patients receiving all types of health services. Funding – $846,321

 Hopi Tribe – The Hopi Tribe Breast and Cervical Cancer Early Detection Program 

delivers education, outreach, and cancer screening services to age and income-eligible 

women living on or near the Hopi Reservation. The Program serves approximately 1,100 

women each year and provides services through the use of mobile mammography and 

partnerships with local healthcare facilities. Beyond providing direct screening services, 

the Program focuses on breast and cervical cancer screening education for all Hopi 

women and extensive case management for women with abnormal results. The Hopi 

Tribe Breast and Cervical Cancer Early Detection Program uniquely excels at reducing 

structural barriers for Hopi women by addressing cultural and geographic barriers to 

screening. Funding – $516,710

 Yukon Kuskokwim Health Corporation (YKHC) – YKHC is run by the 58 tribes in 

the Yukon-Kuskokwim Delta. YKHC has an advanced mobile mammography system, 

which is critical in a region where there are no roads connecting the communities. The 

YKHC B&C target population is Alaska Natives in geographically isolated locations. 

Between July 2007 and June 2012, nearly 3,801 Alaska Native women were served by 

YKHC’s breast and cervical cancer screening program. Funding – $611,000

 Additional awardees include Arctic Slope Native Association (funding – $533,024); 

Cheyenne River Sioux Tribe (funding – $409,544); Kaw Nation (funding – $369,210); 

Native American Rehabilitation Association of the NW, Inc. (funding – $487,968); 

Navajo Nation (funding – $871,109); SouthEast Alaska Regional Health Consortium 

(SEARHC) (funding – $669,732); Southcentral Foundation (funding – $1,242,986); 

South Puget Intertribal Planning Agency (funding – $508,548).

National Comprehensive Cancer Control Program (NCCDPHP/DCPC)

The National Comprehensive Cancer Control Program is a cost-effective approach that brings 

key stakeholders together to develop and implement population-based public health approaches 

to reduce the burden of cancer. Grantees are funded to develop and implement policy, systemslevel, or environmental changes aimed at preventing cancer, detecting cancers early when they 

are more treatable, increasing access to treatment, and improving the quality of life of cancer 

survivors. Awardees include ANTHC (funding – $317,948); Cherokee Nation (funding –

$229,581); Fond du Lac Band of Lake Superior Chippewa (funding – $263,646); Great Plains 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

Tribal Chairmen’s Health Board (funding – $334,230); NPAIHB (funding – $289,295); South 

Puget Intertribal Planning Agency (funding – $263,841); Tohono O’odham Nation (funding –

$197,919). Total funding – $1,896,460

Using Traditional Foods and Sustainable Ecological Approaches for Health Promotion and 

Type 2 Diabetes Prevention in AI/AN Communities (NCCDPHP/DDT)

Total Funding – $1,598,985

 Traditional Living Challenge in Contemporary Times; Indigenous Knowledge for 

Community Wellness – Salish Kootenai College is building on programming that 

focuses on physical activity in relation to traditional foods gathering efforts. The overall 

project activities are blending the ancestral wisdom of traditional foods and lifestyles 

with contemporary realities. Two major components regarding traditional foods will be 

used to support active healthy lifestyles and physical activities based on traditional 

activities with a focus on youth: activities surrounding the permaculture of indigenous 

plants, and continuation of the Ancestors’ Choice social marketing campaign to promote 

a healthy diet and lifestyle for the prevention of type 2 diabetes. Funding – $100,000

 Cherokee Nation Healthy Nation Healthy Foods Project – The Cherokee Nation –

Health Nation project incorporates a variety of activities, including community and 

school gardens, traditional foods gathering trips, traditional Cherokee foods cultivation, 

gathering, preparation, and preservation, traditional Cherokee foods education, and 

incorporation of the traditional Cherokee games Stickball and marbles into community 

and school activities. Over 55,000 members of the Cherokee Nation and their families 

benefited from the initiative’s focus on nutrition, fitness, personal responsibility, and a 

renewed awareness of their shared heritage. Funding – $100,000

 Empowering Ramah Navajos to Eat Healthy (ERNEH) by Using Traditional Foods 

– This project provides materials, training, and technical assistance to families to help 

them grow fresh vegetables in their own yards by using conventional in-ground gardens, 

developing raised bed gardens, or planting in commercially-viable garden boxes. The 

project also encourages physical activity and works to improve access to a greater variety 

of physical activities through community support. The project also provides technical 

assistance and training regarding food use, preservation, and selling excess produce. 

Finally, the book “Traditional Navajo Foods & Cooking,” first published by the Ramah 

Navajo School Board in 1983 will be updated. Forty-five community members 

participating in the gardening project have increased access to healthy traditional food 

fully as a result of the efforts of the ERNEH Project; another 59 have increased access 

partially as a result of project efforts. Sixty-seven Honor Walk participants have 

increased access to information about traditional food fully as a result of the ERNEH 

Project. Funding – $100,000

 Siletz Healthy Traditions – The Confederated Tribes of Siletz Indians’ (CTSI) Siletz 

Healthy Traditions Project promotes health and prevention of diabetes through traditional 

foods and sustainable ecological approaches in the Siletz Indian community, engaging the 

local communities in identifying and sharing healthy traditional ways of eating, physical 

activity, communicating healthy messages and supporting efforts for diabetes prevention 

and wellness. The Project emphasizes traditional foods education, growing, harvesting, 

and preserving of locally grown or caught foods, engagement of community leadership to 
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facilitate food behavior changes, and preserving wisdom through collection of traditional 

stories. The Steering Committee is working on developing healthy policies for CTSI and 

suggestions to be included in the 2015–2025 Comprehensive Plan. Funding – $100,000

 WISEFAMILIES Through Customary and Traditional Living – WISEFAMILIES 

Traditional Foods Program supports community-driven programs that help people adopt 

healthy lifestyles. The Program builds on traditional ways of eating, being active, and 

communicating by storytelling. All activities are developed with the goal to prevent 

chronic illness. Prior to the CDC Traditional Knowledge Program, tribal members 

expressed concern that the “old ways” of gathering and preparing traditional foods were 

being lost. The Wrangell Program has impacted 85% of Alaska Native families in the 

community and the media exposure has included near weekly newspaper articles and 

numerous stories on the local radio station. Funding – $100,000 (to SEARHC)

 Food is Good Medicine – This project offers a model that embraces traditional 

foodways, physical activity, and community empowerment. Featuring the local 

traditional staple food, tanoak acorn, the Got Acorns Campaign was developed and 

launched to promote the health benefits of traditional foods and foodways. Young adults 

participating in the Leadership Program were empowered to explore their identity, 

interview elders and youth significant in their lives, and create digital stories that will be 

shared at community events. Funding – $100,000 (to United Indian Health Services)

 Native Gardens Project: An Indigenous Permaculture Approach to the Prevention –

By reclaiming cultural knowledge and traditions of companion gardening through their 

Native Gardens Project, the Standing Rock Sioux Tribe strives to prevent diabetes and 

contribute to a better quality of life for individuals and families living with diabetes. The 

Nutrition for the Elderly Program Advisory Council, the Standing Rock Special Diabetes 

Program, the state and county Extension Service, Sitting Bull College, and other partners 

support the Native Gardens’ efforts to make local foods from farms and family gardens 

available and accessible. In collaboration with the USDA Nutrition for the Elderly 

Program, the Program documented that 60% of 3,000 vouchers distributed to elders 

generated $9,000 in 2010, encouraging local, certified farmers to keep growing. Through 

4-H and Boys and Girls Clubs, youth are engaged, gathering berries and other wild 

edibles on hikes. Well-advertised winter and summer markets operate consistently, 

providing opportunities to preserve food and share stories through the cold months of 

winter. Funding – $100,000

 Building Community—Strengthening Traditional Ties – The program encourages 

American Indian families to eat nutritious diets and adopt healthy active lifestyles. 

Families participate in school-based health, nutrition, and physical education programs, 

including summertime wellness camps and a theatrical production. The program also 

engages in policy advocacy, and educational programs that emphasize healthy lifestyle 

choices within the context of traditional cultural practices, such as expanding existing and 

creating new neighborhood and school-based gardening projects. Building Community 

established gardening partnerships with two local elementary schools, summer camp 

programs featuring the Coordinated Approach to Child Health curriculum, and worked 

with state policy makers in Oklahoma on healthy food initiatives to address the problem 

of food deserts. Funding – $100,000 (to Indian Health Care Resource Center of Tulsa)
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 The Return to a Healthy Past Project (RTHP) – RTHP has reintroduced traditional 

foods and physical activities in the Prairie Band of Potawatomi Nation to promote health 

and prevent diabetes, among other chronic conditions. Serving as a model for rural and 

urban communities, RTHP has established gardens, increasing production and access to 

traditional produce. Through partnerships with the Land Department, Tribal Council, 

local hunters, and the Diabetes Prevention Program, a wider variety of indigenous 

produce and meats were offered in diabetes education courses, Elders’ Center and 

Language Department gatherings and the Fall Harvest Feast. Traditional forms of 

physical activity have been broadened through nature hikes, camping trips, and gardening 

activities. Community members have increased access to traditional and other physical 

activities due to their exposure to the Project’s activities, such as hiking to identify wild 

plants and traditional foods, including wild onions, milk weeds, etc., and individual or 

family gardens. Funding – $100,000

 Healthy Roots for Healthy Futures – This program works to increase the availability 

and accessibility to healthy, local, traditional foods and traditional forms of physical 

activity. The availability and access to local, traditional, healthy foods have been 

increased through the creation of entrepreneurial training and gardening programs, 

revision of the School Wellness Policy, and development of a farm-to-school system. 

Physical activity is promoted through gardening and trail use. Revitalization of trails 

reconnects communities to the traditional paths of their ancestors, while increasing 

options for physical activity. Funding – $100,000 (to Eastern Band of Cherokee Indians)

 Uniting to Create Traditional and Healthy Environments – The Sault Ste. Marie 

(SSM) Tribe of Chippewa Indians, “Uniting To Create Traditional and Healthy 

Environments” Project, serves seven county service units. Partnership and collaborations 

with other tribal programs and surrounding health services help the project organize, 

support, and serve SSM tribal members. The Project has created a Healthy Traditions 

Advisory Council, which will help the Project to carry out traditional foods, social 

support, and physical activities or events, such as berry picking camp, workshops, 

training master preservers, implementing garden projects, building a Hoop House, 

implementing the harvest feast celebration, involvement in the local farmer’s market, 

fitness promotion, policy change for healthier food fundraising event, and digital 

storytelling. Funding – $100,000

 Listen to the Elders: Healing Nooksack Health through History – The Nooksack 

Indian Tribe’s project involves gardening and planting, distributing garden-related 

materials, increasing community knowledge, awareness and use of traditional foods, and 

increasing physical activities, such canoeing and hunting. Funding – $99,000

 Using Traditional Foods for Health Promotion and Diabetes Prevention – The Aleut 

Diet Program includes sustainable hands-on activities focusing on the healthy preparation 

and use of local traditional foods. The purpose of these activities is to promote health and 

prevent type 2 diabetes in the Aleutian and Pribilof Islands Region of Alaska. The 

Program focus is to improve the nutritional health of people in the region through 

increased awareness of the benefits of traditional foods and the important role these foods 

play in reducing rates of dietary-related diseases such as diabetes, obesity, cancer, heart 

disease, hypertension, and dental caries. The Program also seeks to encourage increased 

consumption of traditional foods from the land and sea by all members of the community 
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as part of a healthy diet. The activities of the Program are centered on culturally relevant 

information dissemination and the development of written resources that speak to the 

nutritional benefits of traditional foods. Funding – $100,000 

 Old Ways for Today’s Health: Red Lake Traditional Foods Project – The Project 

works to reinstate the consumption of a traditional healthy diet at the Red Lake Nation 

using family and community gardens, traditional food gathering encampments such as 

fishing, berry picking, hunting, wild ricing and maple sugar gathering, and cooking 

camps. The Project will collaborate with partners, including the tribal diabetes programs, 

Chemical Health, and community center boards to provide community education through 

media, demonstrations, and community participation. Through the traditional foods 

gathering activities, Red Lake Nation members have an increased opportunity to be 

physically active. With a total of 120 participants in activities during the first six months 

of Year 2, there has clearly been an increase in community members being physically 

active. Funding – $99,985

 Catawba Lifestyle And Gardening Project – The Catawba Cultural Preservation 

Project (CCPP) is increasing awareness and the use of traditional foods and food 

practices by supporting individual and community gardens, and increasing fruits, 

vegetables, beans, and herbs in tribal members’ diets by providing access to local gardens 

and a tribal farmer’s market. The tribe is adopting policies that include preferred 

ecological methods for gardens using traditional growing methods to encourage a new 

generation of environmental stewards to care for the reservation ecosystem. The tribe is 

increasing physical activity with gardening, fishing, and traditional dancing and 

drumming. Innovative partnerships between the tribal Senior Center, CCPP, the Catawba 

Tribal Offices, and a Master Gardener have yielded a successful community garden 

project that is increasing local access to fresh, locally grown, and in some cases 

traditional foods. Elevated box gardens have been constructed for the senior center that 

mitigates the effects of aging on being able to fully participate in gardening. Additionally, 

changes in local practice within the Children’s Programs are becoming a precursor to 

policy change. Emphasis is on elimination of sugar-sweetened beverages, incorporation 

of fresh, locally grown produce into lunch menus, and healthy snack alternatives are the 

focus of changes enacted so far. Funding – $100,000

 O’odham Ha’icu Ha-Hugi c Duakog: Tohono O’odham Food, Fitness & Wellness 

Initiative – The Tohono O’odham Food, Fitness, and Wellness Initiative increases 

knowledge of and access to traditional foods, while engaging the Indian-Oasis 

Baboquivari Unified School District (IOBUSD) and tribal legislation in policy change to 

improve school health environments. Through strengthened partnerships with IOBUSD 

and Head Start, traditional foods were offered in meals and snacks at least weekly during 

the 2010–2011 school year. Trainings and educational workshops were offered to 

teachers and cooks. Y.O.U.T.H members continue to demonstrate leadership and 

innovative approaches to education, youth engagement, and other Tohono O’odham 

Community Action endeavors. Funding – $100,000

Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) 

(NCCDPHP/DHDSP) 

Total funding – $1,001,600
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 Southcentral Foundation provides services to AI/AN women at the Anchorage Native 

Medical Center and the Valley Native Primary Care Clinic. SCF was recognized by 

APHA for making WISEWOMAN screening a standard of care for all women 40–64 

years old presenting for their annual exam and/or a clinical breast exam. Funding –

$500,000

 The Southeast Alaska Regional Health Consortium provides services to AI/AN 

women representing 18 tribes in southeast Alaska. Funding – $501,600

PRC Core Research: Dangerous Decibels program (NCCDPHP/DPH)

Oregon Prevention Research Center’s Center for Healthy Communities collaborates and partners 

with Native communities in Oregon to explore various health disparities and potential ways to 

address these disparities. During the first cycle of funding, core research projects were aimed at 

addressing the prevalence and impact of vision and hearing impairment and potential 

improvements to quality of life through correction (i.e., eye glasses and hearing aids) among 

some of the tribes in the Northwest and Midwest United States. During the second cycle of 

funding, focus was shifted to the prevention of noise-induced hearing loss and tinnitus in these 

same communities. Funding – $535,610

PHHS Block Grant – Kickapoo Physical Activities Program (NCCDPHP/DPH)

The Kickapoo Tribe in Kansas continues promote physical activity to members of the Boys & 

Girls Club of the Kickapoo Tribe for youth between the ages of 5 and 21 years. The Kickapoo 

Tribe has developed and implemented an after school program that promotes physical activity 

through the use of sports, games, and cultural teachings. Through coordinated activities with 

various tribal, national, state, and local entities that promote the overall health and well-being of 

tribal members. The major health objective is HO 22-6 which is to provide physical activity in 

children and adolescents. Funding – $20,185

PHHS Block Grant – Santee Sioux Tribal EMS Program (NCCDPHP/DPH)

The goal of the Santee EMS Program is to provide quality Emergency Medical Services 24 hours 

a day, 7 days a week, and 365 days a year to the members of the Santee Sioux Nation, partnering 

with the Santee Health Center for non-emergent healthcare needs. Funding – $20,185

First Ever Training on Investigating Infant Deaths in Indian Country (NCCDPHP/DRH)

DRH, in partnership with Michigan Public Health Institute’s National Center for the Review and 

Prevention of Child Deaths and IHS Injury Prevention, sponsored the first ever training for 

investigating Sudden Unexpected Infant Deaths in Indian Country. More than 60 Navajo and 

Pueblo police officers, FBI agents, and other law enforcement officials completed a two-day 

training on April 25–26, 2013, to better investigate and recognize deaths of children from child 

abuse and sudden and unexplained deaths. Criminal investigators, police officers, and other first 

responders were coached on techniques including scene evaluation, evidence collection, scene 

recreation, and doll re-enactments, while honoring the child and family. American Indian babies 

die from Sudden Infant Death Syndrome and other Sudden Unexpected Infant Deaths at rates 

three times higher than white and Hispanic babies. The causes of these deaths can sometimes be 

difficult to identify and may include child abuse. Often an autopsy will not identify 

circumstances surrounding the child’s death; only a high-quality death scene investigation can 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

provide better answers for the medical and law enforcement investigators and the family. 

Funding – $50,000

Pregnancy Risk Assessment Monitoring System Tribal Flu Project (NCCDPHP/DRH)

The Pregnancy Risk Assessment and Monitoring System (PRAMS) Tribal Flu Project is an 

initiative to obtain representative data from American Indian mothers about their perceptions of 

and experience with H1N1 and seasonal influenza using the state-based PRAMS. In May 2011, 

New Mexico, Oregon, and Washington were approved for two years of funding, and Wyoming 

PRAMS joined our initiative without funding. Funded state health departments were charged 

with adapting their PRAMS-related epidemiologic and managerial support to work 

collaboratively with tribes in a manner respecting tribal sovereignty, with the ultimate project 

outcome being establishment or improvement of partnerships with tribes, increased response 

rates among AI women, and increased data sharing with tribes. Funding – $142,691

Support for Maternal and Child Health (MCH) Epidemiologist and Public Health Advisor

(NCCDPHP/DRH)

The Maternal and Child Health Epidemiology Program (MCHEP) is a collaborative effort 

between CDC and the HRSA Maternal Child Health Bureau. Since 1987, MCHEP has assigned 

more than 35 senior CDC epidemiologists focused on MCH epidemiology capacity building and 

applied research to promote and improve the health and well-being of women, children, and 

families by providing direct assistance to public health agencies through assigning senior CDC 

MCH epidemiologists and fellows. 

 The MCH epidemiologist assigned to the Northwest Tribal Epidemiology Center, on 

behalf of NPAIHB, provided consultation, technical assistance, surveillance, and analysis 

of epidemiologic information. Funding – $96,601.77 (annual salary)

 DRH provided support for a public health advisor assigned to the IHS Division of 

Epidemiology and Disease Prevention, working in MCH, reproductive health, and STD 

prevention efforts among adolescents. Funding – $142,951.07

Tribal Tobacco Control Program to Reduce Commercial Tobacco Use Among AI/AN

(NCCDPHP/OSH)

Total funding – $1,865,340

 Cherokee Nation – Cherokee Nation (CN) Community Health Promotion Program 

within the CN Health Services Division partners with schools, communities, worksites, 

and healthcare settings within the Cherokee Nation tribal jurisdiction to implement 

policy, systems, and environment change. CN Tobacco Prevention Program interventions 

and strategies are organized around the MPOWER framework to guide policy, systems, 

and environment changes. The Program goal is to make CN citizens healthier by making 

the healthy choice, the easy choice for all tribal citizens. Funding – $200,000

 Muscogee Creek Nation – The Muscogee Creek Nation (MCN) Tobacco Prevention 

Program (TPP) works within the MCN Division of Health. TPP works with 26 

community centers and 63 public schools within the Muscogee (Creek) Nation district to 

reduce exposure to secondhand smoke among its citizens by promoting commercial 

tobacco-free work buildings and premises of all MCN-owned buildings. TPP works to 

reduce commercial tobacco abuse among tribal members by engaging tribal elders, 
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leaders and communities in activities that will encourage tribal members who use tobacco 

products to quit and collaborate with partners to eliminate youth access to tobacco 

products through various strategies. TPP interventions and strategies are organized 

around the MPOWER framework to guide policy, systems, and environment changes. 

The Program goal is to work toward decreasing the adult prevalence target of five percent 

by the end of the project period. Funding – $250,000

 Great Plains Tribal Chairmen’s Health Board – Great Plains Tribal Chairmen’s 

Health Board formed the Northern Plains Tribal Tobacco Technical Assistance Center 

(NPTTTAC) to monitor commercial tobacco use and policies among the 17 federally 

recognized tribes and one Indian Service Area within the states of North Dakota, South 

Dakota, Nebraska, and Iowa. NPTTAC has been highly successful in strengthening 

partnerships with the Aberdeen Area IHS and state health departments (North Dakota, 

South Dakota, Nebraska, and Iowa). They continue to build on those relationships and 

coordinating efforts and resources to work in partnership with tribes, IHS, and states. 

NPTTTAC is working toward leveraging state partnerships to provide additional funding 

to support tribal tobacco control activities. Funding – $232,670

 Tanana Chiefs Conference (TCC) – TCC’s Cultural Integration of Tobacco Policy 

Project works in partnership with the TCC tribal villages and membership to create and 

implement tobacco policy to address and help prevent health disparities related to higher 

tobacco use among Alaska Natives in rural areas. TCC Health Services has provided 

health care to Alaska Native people living within its service area since 1973. As the 

traditional tribal consortium with 42 members representing 39 villages and 37 federally 

recognized tribes in the interior of Alaska, TCC is tasked with pursing funding and 

resources to provide services that benefit the well-being of the tribal members it serves. 

In recent years, TCC has moved considerable resources from providing care after a 

problem has occurred to being more proactive in prevention and early intervention. In the 

course of this shift, TCC has been working with the leadership and members of the 

Villages we serve to engage and empower them in this process. The Tobacco Control and 

Prevention initiative supports this effort. Funding – $250,000

 Additional awardees include Black Hills Center for American Indian Health (funding –

$250,000); Inter-Tribal Council of Michigan (funding – $232,670); Nez Perce Tribe

(funding – $200,000); SEARHC (funding – $250,000).

A Prospective Birth Cohort Study Involving Uranium Exposure in the Navajo Nation 

(NCEH/ATSDR/DTHHS)

The purpose of this study is to evaluate environmental uranium exposure by recruiting Navajo 

mothers, assessing their uranium exposure at key developmental milestones, and following the 

children post-birth to assess any associations with birth defects or developmental delays. 

Extensive uranium mining and milling have occurred in the Navajo Nation during the last half 

century. While there have been many studies of environmental and occupational exposure to 

uranium and associated renal effects in the adult population, there have been very few studies of 

other adverse health effects. There is limited epidemiologic and toxicological information 

indicating that uranium may pose a risk to the developing fetus. Applied public health objectives 

of the study are to provide health education to help mitigate uranium exposure, increase prenatal 
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care utilization among Navajo mothers, and deliver earlier assessment and referral for identified 

developmental delays. Funding – $1,000,000 through the University of New Mexico 

Laboratory Support for a Prospective Birth Cohort Study Involving Environmental 

Uranium Exposure in the Navajo Nation (NCEH/ATSDR/DLS)

The DLS Inorganic and Radiation Analytical Toxicology and Clinical Chemistry Laboratories 

provides technical assistance for a study conducted by the University of New Mexico to 

investigate exposure concerns in Navajo Nation communities affected by uranium waste. DLS is 

currently analyzing 1,200–1,300 urinary and blood specimens for antimony, barium, beryllium, 

cadmium, cesium, cobalt, lead, manganese, molybdenum, platinum, strontium, thallium, tin, 

tungsten, uranium; total and speciated arsenic; lead, cadmium, mercury, manganese, selenium; 

mercury speciation; and creatinine. Funding – No specific award

Association of BPA, Arsenic Levels, and Diabetes among Persons Living in the Cheyenne 

River Sioux Tribe (CRST) (NCEH/ATSDR/DLS)

DLS, Inorganic and Radiation Analytical Toxicology, Organic Analytical Toxicology, and 

Clinical Chemistry Laboratories provided technical assistance for a study conducted by CDC's 

Division of Environmental Hazards and Health Effects Health Studies Branch in collaboration 

with the Cheyenne River Sioux Tribe (CRST). The goal of the study is to quantify bisphenol A 

(BPA) and arsenic concentrations in a Native American population, specifically in persons living 

in the CRST Reservation, and assess the association between these environmental chemicals and 

the clinical disorder diabetes mellitis. DLS provided collection and shipping supplies and labels 

as needed and analyzed 300 urine samples for total arsenic, BPA, and creatinine, as well as 100 

urine samples for arsenic species. Funding – No specific award

Nicotine Exposure and Metabolism in Alaska Native Adults Research Study 

(NCEH/ATSDR/DLS)

The DLS Emergency Response and Air Toxicants Branch provided in-kind laboratory analysis 

via agreement with the Alaska Native Medical Center/IHS on a cross-sectional study of 400 

Alaskan Native adult tobacco users, 50 male and female smokers, commercial chew users, 

iq’mik users and non-tobacco users who received medical services in Dillingham, Alaska. The 

objective of the study was to generate information on nicotine and carcinogen exposure in 

underserved Alaska Natives. DLS completed chemical analysis of Alaskan iq’mik, a native 

smokeless tobacco mixture that combines tobacco and fungus/plant ash, and performed 

measurements in urine for cotinine (a nicotine byproduct). Select findings were published in FY 

2013. Funding – No specific award

Maternal Organics Monitoring Study (MOMS) (NCEH/DLS)

Exposure to persistent organic pollutants, heavy metals, and radionuclides in the environment 

may increase a newborn’s risk of developmental, neurological, and immunologic effects. Alaska 

Native women are potentially exposed to these chemicals because their diet of fish and marine 

mammals has been shown to bioconcentrate organochlorine chemicals and heavy metals and 

atmospheric transport of nuclear fallout and accidents has spread radioactive materials over the 

circumpolar region. The aim of this study, led by ANTHC, is to investigate associations of 

individual contaminants or groups of contaminants with pregnancy outcomes and risk of 
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

infectious disease as well as growth and development outcomes in the child’s first year of life. 

DLS will provide technical assistance by measuring lipid content, polychlorinated biphenyls, 

polybrominated diphenyl ethers, organochlorine pesticides, perfluorochemicals, Vitamin D, lead, 

manganese, mercury, selenium, and total mercury in biological samples. Funding – No specific 

award

Trainings in Anchorage, Alaska and Tahlequah, Oklahoma with Environmental Health 

Officials on the Biology and Control of Vectors and Public Health Pests (NCEH/DEEHS)

In response to the decline of vector control capacity at the state, tribal, and local health 

departments, EHSB partnered with the National Environmental Health Association to develop a 

course titled “Biology and Control of Vectors and Public Health Pests: The Integrated Pest 

Management” (IPM). Course topics are tailored to the state or region where the course is offered. 

The course typically includes rodent control, IPM, health effects of pesticides, and emerging pest 

issues such as bed bugs. The Cherokee Nation Office of Environmental Health sponsored this 

CDC training in Tahlequah, Oklahoma, on June 18–20, 2013. The Alaska Environmental Health 

Association hosted this training in Alaska on August 6–8, 2013. Funding – No specific award

Association of Environmental Health Academic Programs (NCEH/DEEHS)

Through its CDC cooperative agreement, the Association of Environmental Health Academic 

Programs (AEHAP) works with TCUs to develop and promote formal environmental health 

training at TCUs. Since most TCUs are two-year colleges and are not eligible for accreditation 

from the National Environmental Health Science and Protection Accreditation Council (EHAC), 

AEHAP is working with TCUs to create environmental health curricula to generate TCU 

students’ interest in environmental health. Students who take courses in environmental health 

will be far more likely to continue their education by majoring in environmental health at EHAC 

accredited programs after they obtain associate degrees. For example, in 2011 with AEHAP’s 

support, Salish Kootenai College (SKC) formalized an environmental health track to its existing 

bachelor of science program in life sciences. SKC is the only tribal college with a four-year, 

“molecular-based” (i.e., “hard science”) degree. They now have two tracks to this degree –

cellular biology and environmental health. Currently, this track would fall short of EHAC 

accreditation because it is designed to facilitate student matriculation into environmental health 

types of graduate programs. AEHAP is working with the program to discuss the possibility of 

developing an online program for students in other TCUs. This would involve an assessment of 

the type of courses needed to meet EHAC Guidelines. Funding – $10,000

NCEH/OTA National Tribal Environmental Health Think Tank (NCEH/ATSDR/OTA, 

OSTLTS/PHLP)

The National Tribal Environmental Think Tank is tasked with 1) characterizing the priority 

environmental public health issues facing tribal communities, 2) determining which 

NCEH/ATSDR divisions and branches are best suited to address these issues, and 3) offering 

actionable recommendations for NCEH/ATSDR leadership on how best to collaborate and 

engage with tribes on the selected issues. The National Tribal Environmental Think Tank 

convened tribal leaders to determine environmental health priorities on November 13–14, 2012,

February 21–23, 2013, and July 9–11, 2013. Funding – No specific award
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

Effective Strategies to Reduce Motor Vehicle Injuries Among AI/AN (NCIPC/DUIP)

This program is to design and tailor, implement, and evaluate Native American communitybased interventions with demonstrated effectiveness for preventing motor vehicle injuries within 

the following areas: 1) strategies to reduce alcohol-impaired driving among high-risk groups; 2) 

strategies to increase safety belt use among low-use groups; and 3) strategies to increase the use 

of child safety seats among low-use groups. An overriding intent of this funding is to assist tribes 

in developing evidence-based effective strategies in programs, which take into consideration the 

unique culture of Native Americans. Funding was awarded to eight grantees at approximately 

$70,000 per grantee. The eight funded tribes are the Colorado River Indian Tribes (Mohave, 

Chemehuevi, Hopi and Navajo), SEARHC, California Rural Indian Health Board on behalf of 

the Yurok Tribe, Sisseton Wahpeton-Oyate of the Lake Traverse Reservation, Rosebud Sioux 

Tribe, Caddo Nation of Oklahoma, Oglala Sioux Tribe Department of Public Safety, and Hopi 

Tribe through the Office of Health Services (Arizona). The period of performance is September 

2010 through September 2014. Funding – $560,000

DSNS Mass Antibiotic Dispensing Workshop in Flagstaff, Arizona (OPHPR/DSNS)

On August 28–29, 2013, Robert Garcia and Barbara Cooper of CDC/OPHPR/DSNS Training 

Team, in collaboration with the OPHPR’s Division of State and Local Readiness Program 

Services Branch, facilitated the training of 70 participants in medical countermeasure dispensing 

operations for a large-scale public health event. Participants were predominately American 

Indian tribal members or American Indian preparedness partners from Arizona, New Mexico,

and Utah. Arizona’s Bureau of Public Health Emergency Preparedness within Arizona’s 

Department of Health Services made the request for training on behalf of the Navajo Nation. The 

DSNS training team conducted the two-day workshop, the “Mass Antibiotic Dispensing 

Workshop,” or “MAD”) in Flagstaff, Arizona. CDR Robert Garcia, MAD course manager, 

designed the training using a compilation of medical countermeasure training modules and 

tailored the workshop to address cultural, geographic, and other considerations. These trainings 

support the readiness of personnel for exercises and any future real-world events. Additional 

workshops are planned in 2013 and 2014 for other regions of the Navajo Nation in coordination 

with Bureau of Health Emergency Management, Epidemiology & Response Division within the 

New Mexico Department of Health. Funding – No specific award

Considerations for Managing Laboratory Specimens from Native Americans 

(CSELS/DLPSS, OSTLTS)

In response to a request, Dr. David Holmes and Ms. Delight Satter co-presented “Considerations 

for Managing Laboratory Specimens” to the CDC Tribal Advisory Committee during its 

February 2013 Meeting. This presentation provided an overview of the CDC’s approach for 

addressing policy considerations specific to Native American specimens. 

Epi-Aid 2013-018: Tuberculosis Outbreak among American Indians (North Dakota) 

(CSELS/DSEPD)

In October 2012, cases from a tuberculosis outbreak began appearing among American Indians 

in Grand Forks County, North Dakota. Risk factors identified include homelessness, 

incarceration in a local jail, and substance use. This Epi-Aid provided recommendations for 

tuberculosis control and prevention in this population. Funding – No specific award
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Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

Epi-Aid 2013-035: Group A Streptococcal Disease among Navajo Nation Citizens of 

Apache County, Arizona (CSELS/DSEPD, NCIRD)

During January 8–February 23, 2013, six laboratory-confirmed invasive Group A Streptococcal 

(iGAS) infections and one suspected iGAS infection were identified among Navajo Nation 

citizens who seek care at a single IHS facility in Chinle, Arizona, which serves approximately 

45,000 persons. A two-week Epi-Aid investigation was conducted in March 2013. The Epi-Aid 

team assisted the Navajo Epidemiology Center (NEC) and IHS/Chinle staff with identifying 

persons infected with iGAS, evaluating current iGAS surveillance and procedures, determining 

epidemiological or microbiological links between cases, developing prevention and control 

measures, and assisting the NEC and public health nurses with communication messages 

concerning iGAS infections. The team documented a two–three-fold increase in iGAS infections 

compared with similar months in previous years. However, no significant epidemiological or 

microbiological links were identified that would suggest a common source or sources. Funding –

No specific award

Epi-Aid 2013-57: Healthful Nutrition in Navajo Nation Stores (CSELS/DSEPD, 

NCCDPHP)

Leadership in the Navajo Nation is growing increasingly concerned about the rise of obesity 

among the youth and adult Navajo Indian populations, and comprehensive information about the 

nutritional quality of food sources in the region is scarce. An Epi-Aid investigation was 

conducted in July 2013 in Window Rock, Arizona to assist the Navajo Division of Health with a 

baseline assessment of the nutrition environment in grocery and convenience stores across the 

Navajo Nation, and evaluate risk factors associated with poor nutrition and obesity in this 

population. In addition, the Navajo Nation plans to create policy and wellness changes to address 

the rising obesity concern. Funding – No specific award

Epi-Aid 2013-077: Rapid Assessment of Emergency Tick Prevention Efforts on the San 

Carlos Apache Reservation Following an Epidemic of RMSF (CSELS/DSEPD, 

NCEZID/DVBD)

RMSF is a severe and potentially fatal tick-borne bacterial disease that has recently emerged as a 

significant public health threat on some tribal lands in Arizona. The public health problem posed 

by RMSF is amplified by dog overpopulation and a lack of veterinary support and animal control 

programs. Since 2003, human RMSF cases have been reported in six reservations, with over 250 

human cases and 19 deaths. A significant proportion of these cases have occurred on the San 

Carlos Apache Reservation in eastern Arizona. The objective of this Epi-Aid was to inform and 

strengthen RMSF control measures on the San Carlos Apache reservation. Team members from 

CDC, USDA, IHS, and the Arizona Department of Health Services conducted about 650 home 

visits and 400 surveys assessing tick activity and attitudes and acceptance of tick control 

measures around the reservation. Within the intervention area, ticks were observed on only 2% 

of dogs, while outside the intervention area, ticks were observed on 33% of dogs, significantly 

lower than previously measured, but still above the target of <10%. Preliminary results were 

provided to the tribe in early October and were presented at a state RMSF partners meeting 

December 3-5. Funding – No specific award
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FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

EIS Officer Placed at the Northwest Tribal Epidemiology Center (CSELS/DSEPD)

The Epidemic Intelligence Service (EIS) matched an EIS officer to a newly-created EIS 

assignment at the Northwest Tribal Epidemiology Center (NWTEC) of NPAIHB in Portland, 

Oregon. The NWTEC is one of 12 tribal epidemiology centers across the country, and receives 

funding from multiple sources, including CDC and IHS. NPAIHB is a non-profit tribal 

organization and represents 43 tribes in Idaho, Oregon, and Washington. The EIS officer will 

work with the tribes to develop and conduct projects that serve the interests of the tribes while 

meeting the EIS program Core Activities for Learning. Funding – No specific award

Evaluation of IHS’s NDW System as a Method for Communicable Disease Surveillance in 

AI/AN Communities of the Portland IHS Area (ID, OR, WA) (CSELS/DSEPD)

AI/AN communities experience disproportionate burdens of disease. Currently, no system 

provides aggregate health data of Portland IHS Area (ID, OR, WA) AI/AN communities to tribal 

public health authorities, who do not have ready access to state health department data. The 

National Data Warehouse (NDW)—a repository of clinical data from IHS, tribal, and urban 

Indian clinics—is a rich source of health data for AI/ANs and might be useful as a disease 

surveillance system. The EIS officer, at the request of the IHS area medical epidemiologist and 

with NPAIHB member approval, will evaluate the NDW as a surveillance system for six 

communicable diseases: hepatitis A, B, and C, gonorrhea, chlamydia, and pertussis. Preliminary 

findings indicate that while there are limitations to using the NDW as a surveillance system, it 

could prove useful for AI/AN-specific public health surveillance to detect trends in reportable 

communicable diseases, guiding development of future AI/AN-specific public health 

surveillance systems. Funding – No specific award

Epi Info Technical Assistance (CSELS/DEALS)

On January 23, 2013, the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC) 

requested technical assistance with using Epi InfoTM 7 to collect tribal BRFSS survey data using 

Android tablets. The BRFSS is a system of health-related telephone surveys that collect state 

data in all 50 states, the District of Columbia, and three US territories regarding health-related 

risk behaviors, chronic conditions, and use of preventive services. The data are used to help 

states establish and track state and local health objectives, plan health programs, implement 

disease prevention and health promotion activities, and monitor trends. An AASTEC 

epidemiologist traveled to Atlanta to participate in Epi Info 7 training (May 14–15, 2013). The 

Epi Info team also provided technical assistance in Atlanta (May 13 and May 16, 2013), and 

ongoing assistance with troubleshooting when the AASTEC representative returned to New 

Mexico. AASTEC successfully administered the BRFSS using Android tablets in October 2013 

and plans to start the analysis phase of the project using Epi Info 7 in January 2014. Funding –

No specific award

Presentation at the 1st Annual Navajo Nation Safety and Health Conference (NIOSH)

During June 11–14, 2013, NIOSH staff attended the 1st Annual Navajo Nation Safety and Health 

Conference in Albuquerque, New Mexico, and presented on NIOSH and NIOSH’s new tribal 

initiative to provide occupational safety and health support to AI/AN communities. Participation 

at the conference involved staffing a NIOSH informational booth, meeting and speaking with 
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FY 2013 HHS Tribal Consultation Report 

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

attendees about NIOSH and their work, answering questions, and providing information about 

NIOSH and NIOSH’s new tribal initiative. Funding – No specific award 

III. Senior Leadership Visits to Tribes 

NCCDPHP Visit to NWTEC/NPAIHB, June 27-28, 2013 

On June 27, 2013, NCCDPHP Director Ursula Bauer, MCHEP Lead, Dr. Charlan Kroelinger, 

and DRH Tribal Liaison, CAPT Myra Tucker, met with Dr. Victoria Warren-Mears, NWTEC 

Director, and NPAIHB staff to discuss programs, projects, and activities, and to learn ways that 

NCCDPHP and MCHEP may offer technical assistance in the future. Dr. Kroelinger and CAPT 

Tucker also met with Dr. Warren-Mears to close the placement of a CDC assignee at NWTEC. 

Drs. Bauer, Kroelinger, and CAPT Tucker also participated in a meeting between the NWTEC 

and Oregon Public Health Authority staff to discuss how the state health department and the 

Tribal Epidemiology Center could collaborate on maternal and child health activities targeting 

tribal populations. On June 28, Dr. Bauer met with Joe Finkbonner, NPAIHB Executive 

Director. Tribal leaders participated in a meeting with Director Bauer, Dr. Kroelinger, CAPT 

Tucker, and Dr. Warren-Mears. The tribal leadership meeting provided an opportunity to learn 

about the impact of the Community Transformation Grants (CTG) on the Makah Tribe and the 

Chehalis Tribes—to increase community opportunities for healthy eating, active living, and 

tobacco-free living; learn ways to more effectively communicate with tribal leaders and tribes; 

discuss tribal needs, including data sharing and technical assistance; and listen to tribal leaders 

discuss the challenges of working with the federal government. 

Meeting with NIOSH and the Navajo Nation Occupational Safety and Health 

Administration (NNOSHA) (NIOSH) 

On August 19–20, 2013, the NIOSH Western States Office hosted three representatives from 

NNOSHA. Presentations included overviews of NIOSH, NNOSHA, and the Mountain and 

Plains Education and Research Center, and provided information on specific programs, including 

the NIOSH Fatality Assessment and Control Evaluation Program, the NIOSH Health Hazard and 

Evaluation Program, and the Navajo Nation’s Safety Loss Control Program. The meeting was an 

opportunity to discuss worker safety and health priorities for NNOSHA and identify potential 

areas of collaboration. Another meeting is scheduled for February 2014. 

Great Lakes Inter-Tribal Council, Inc., September 23-25, 2013 

On September 23–25, 2013, Dr. Leonard Jack, Jr., Director of the Division of Community 

Health, and DCH staff visited the Great Lakes Intertribal Council, Inc. to gain a programmatic 

overview consisting of progress, barriers, successes and technical assistance needs towards 

achieving program goals and objectives. The visit consisted of two days of culturally relevant 

information significant towards programmatic approaches of CTG activities. 

IV. Affordable Care Act Activities specific to Tribes 

National Public Health Improvement Initiative (NPHII) (OSTLTS/DPHPI) 

$7,240,348 ($2,459,994 for Year 1; $2,443,662 for Year 2; and $2,336,692 for Year 3) has been 

awarded to eight tribal governments or organizations funded through NPHII that support 
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FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

approximately 250 federally recognized tribes. In Year 3, there were seven tribal governments or 

organizations funded (four directly-funded tribes and three tribal organizations). 

 Alaska Native Tribal Health Consortium, Division of Community Health Services is 

collaborating with the state of Alaska on a statewide health assessment—the Healthy 

Alaskans 2020 (HA2020) initiative—and actively participates in the initiative’s working 

groups and advisory team. The HA2020 advisory team has used a variety of 

technological solutions (including instant polling systems, SharePoint, and 

AdobeConnect interactive meetings) to overcome travel and funding obstacles and large 

geographical dispersion. An online survey tool was deployed to obtain community of 

interest input on leading health indicators (LHIs) for HA2020, with two surveys 

capturing a total of over 3,300 respondents. These helped generate a list of HA2020 

LHIs, target measures, and evidence-based strategies to meet LHIs and ultimately a 

HA2020 report for dissemination and posting on the web. ANTHC participates in the 

State of Alaska Indicator-Based Information System for Public Health, providing input 

on the development of performance tracking for HA2020 indicators. Additionally, the 

Healthy Alaskans 2010- Health Status Progress Report of Leading Health Indicators was 

completed in January 2013. ANTHC has also performed an organizational selfassessment to determine conformity with national public health standards. ANTHC 

continues working in the area of tobacco cessation, increasing referrals and services to 

reduce tobacco use among Alaska Native people. They are also expanding dissemination 

of Alaska Native health status information through the Alaska Native Epidemiology 

Center data website. Funding – $250,000

 Cherokee Nation (CN) Health Services was able to hire a surveillance coordinator and 

complete the tribal health assessment, tribal health improvement plan, and tribal strategic 

plan. CN submitted its application to the Public Health Accreditation Board (PHAB) in 

May 2013. The first-ever “State of the Nation” health report is available on CN’s new 

public health website, www.cherokeepublichealth.org. Funding – $843,662

 Gila River Indian Community (GRIC) is working towards transitioning from a manual 

to an electronic disease surveillance system, which is expected to result in reduced staff 

time required for data entry and more accurate reports. GRIC has also begun developing 

standardized protocols for disease investigation and follow up. Funding – $250,000

 Mille Lacs Band of Ojibwe Public Health Department (MLBO) is completing a tribal 

health assessment and has begun using software to track clinical services that are 

provided. Using the software will result in decreasing the amount of staff time spent on 

case management and reducing duplication of services. MLBO has also been developing 

emergency preparedness and response policies and procedures for the health department. 

Funding – $243,032

 Montana Wyoming Tribal Leaders Council (MWTLC) is helping to strengthen tribal 

public health capacity by supporting the development of health codes on each reservation 

in Montana and Wyoming. A model health code has been developed for use by tribes and 

nine of ten tribes have each formed teams for overseeing development and 

implementation of health codes. MWTLC staff and consultants have also collaborated 

with Montana and Wyoming tribal health departments in conducting a feasibility study 

on workforce improvement, showing the continued need for workforce development and 

workspace improvement. They are also working towards the implementation of the 
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FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

PHAB assessment among all tribes. Seven tribes are participating in updating their 

National Public Health Performance Standards Program Local/Governance assessment 

tools, conforming to the PHAB Standards. A total of $160,000 in mini-grants was 

distributed to eight area tribes for capacity building towards accreditation. MWTLC has 

also completed and disseminated baseline tribe-specific community health profiles for 

Montana and Wyoming tribes (2006–2009) and is beginning data collection, cleaning,

and analysis for the next report in 2014/2015 (2010–2013). MWTLC has a long-term 

goal of developing a final lessons learned document to disseminate among all Montana

and Wyoming tribes, other American Indian tribes, and funding agencies. Funding –

$250,000

 Navajo Nation Division of Health (NNDOH) developed a standardized protocol for 

sharps disposal in the HIV clinic. NNDOH has also succeeded in decreasing the amount 

of time required to classify new positions before personnel can be hired, developed a 

quality improvement plan, and made progress towards transitioning from a division to a 

department of public health within the Navajo Nation government. Funding – $250,000

 Northwest Portland Area Indian Health Board provides culturally competent training 

and technical assistance to 43 member tribes in support of the development, 

implementation, and completion of tribal community health assessments, health 

improvement plans, and agency strategic plans. NPAIHB continues to offer public health 

accreditation training and disbursed $90,000 in mini-grants to nine area tribes to support 

tribal health departments working on accreditation readiness activities and quality 

improvement projects. Technical assistance on PHAB standards and Lean management 

principles is also offered to support performance management. NPAIHB maintains crossjurisdictional partnerships with the Idaho, Oregon, and Washington performance 

improvement managers as well as the Northwest Center for Public Health Practice and 

participates regularly in tribal, board, national, and regional network steering committee 

meetings. Funding – $249,998

Community Transformation Grant Program: Small Communities (NCCDPHP/DCH)

The CTG Small Communities Program is aimed at improving the health of small communities 

across the nation. The two-year grants were awarded to governmental and non-governmental 

agencies and organizations across a variety of sectors, including transportation, housing, 

education, and public health, and tribes and tribal organizations, to increase opportunities for 

people to make healthy living easier and improve health in communities of up to 500,000 people. 

 Coeur d’Alene Tribe – The Benewah Medical Center—an accredited, comprehensive, 

ambulatory community health center, owned and operated by the Coeur d’Alene Tribe—

is working to improve overall community health of the Coeur d’Alene Indian Reservation 

by increasing access to preventive care, reducing tobacco use, improving nutritional 

habits, and increasing physical activity. The project, Preventing Health Issues Through 

Transformation, will focus on assessing the needs of the community and identifying areas 

for improvement. This work may impact approximately 19,000 residents living in lowincome, racial/ethnic minority, and medically underserved communities in two Idaho and 

two eastern Washington counties. Funding – $405,820.46 (two years, forward-funded)

 Cherokee Nation – The Cherokee Nation is continuing work to develop tribal-specific 

approaches for preventing and reducing tobacco use and obesity, increasing physical 
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FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

activity and improving nutrition. These approaches will help to reach long-range, highimpact tribal public health goals that for approximately 389,000 residents living in 14 

counties in northeastern Oklahoma, with a focus on low-income, racial/ethnic minority, 

and medically underserved communities and persons affected by mental illness or 

substance abuse. Funding – $1,287,191.10 (two years, forward-funded)

 Tohono O’odham Community Action – The goal of the Tohono O’odham Heritage of 

Health Initiative (TOHOHI) is to reduce obesity and type 2 diabetes on the Tohono 

O’odham Nation. TOHOHI is using school-based programs to increase access to locally

grown foods, enroll eligible students in free or reduced-price school meal programs, 

involve school gardens and O’odham sports, and teach healthy behaviors. The initiative is 

also offering community-level nutrition and cooking programs, with locally farmed 

foods, geared to individuals and families. These changes may benefit up to approximately 

200,000 medically underserved residents in southern Arizona. Funding – $200,000

Community Transformation Grant Program: Capacity Building (NCCDPHP/DCH)

The CTG Program is working to create healthier communities by making healthy living easier 

and more affordable. Concentrating on the causes of chronic disease, awardees are improving 

health and wellness with strategies that focus on areas such as tobacco-free living, active living 

and healthy eating, and clinical and community preventive services to prevent and control high 

blood pressure and high cholesterol. Capacity building awardees are establishing a solid 

foundation for community prevention efforts, by developing the human capital, skills, and 

partnerships, to ensure long-term success.

 Confederated Tribes of the Chehalis Reservation –The tribe is working to assess 

public health conditions of the Chehalis people and the community of Oakville and build 

capacity to implement strategies and solutions to problems identified, along with 

identified resources, partners, preferences, and local conditions. Funding – $498,663

 Great Lakes Inter-Tribal Council, Inc. (GLITC) – GLITC has increased infrastructure 

components by partnering with other tribes, established a leadership team, formed an 

active coalition to support community health work, and completed community health 

assessments and policy scans in each community. GLITC will build on its existing 

relationships, policy-making experience, and community health assessment and 

communication skills to develop a Community Transformation Plan to implement 

strategies to reduce the burden of chronic disease in its communities. Funding – $499,982

 Sophie Trettevick Indian Health Center – The Makah Community Transformation 

Project has generated interest and excitement related to changing environments and 

creating opportunities to live long, healthy lives free of chronic disease in their 

community. They have established a leadership team, formed and evaluated their CTG 

coalition, leveraged funding and resources to support identified needs, completed 

assessments, and prioritized strategies, and are beginning to implement health eating and 

active living pilot projects. Funding – $218,929

 Toiyabe Indian Health Project (TIHP) – TIHP is a two-site health clinic in eastern 

California serving nine Paiute and Shoshone Tribes and tribal communities which 

provides comprehensive medical, dental, dialysis, community health, and mental health 

services to over 3,000 Native American patients in Inyo and Mono Counties. TIHP is 

working to increase the number of infrastructure components supporting CTG strategies, 
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FY 2013 HHS Tribal Consultation Report 

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

including leadership team, coalition, community health assessments, and technical 

assistance. They are also working to implement several physical activity pilot projects 

and two healthy eating infrastructure projects. Funding – $500,000 

 Yukon-Kuskokwim Health Corporation (YKHC) – YKHC administers a 

comprehensive healthcare delivery system for 58 rural communities in southwest Alaska. 

YKHC is working to increase the number of infrastructure components supporting CTG 

strategies, including leadership team, coalition, community health assessments, and 

technical assistance. Funding – $193,340 

Community Transformation Grant Program: Implementation (NCCDPHP/DCH) 

The CTG Program is working to create healthier communities by making healthy living easier 

and more affordable. Implementation awardees are improving health and wellness by 

implementing strategies that focus on areas such as tobacco-free living, active living and healthy 

eating, and clinical and community preventive services to prevent and control high blood 

pressure and high cholesterol. 

 Sault Ste. Marie Tribe of Chippewa Indians – The Sault Ste. Marie Tribe of Chippewa 

Indians is receiving $500,000 to serve an estimated tribal population of over 176,000 

within the state of Michigan. Work will target tobacco-free living, active living and 

healthy eating, quality clinical and other preventive services, and healthy and safe 

physical environments. Funding – $500,000 

 Southeast Alaska Regional Health Consortium – SEARHC is receiving $499,588 to 

serve an estimated population of 72,000 within the state of Alaska. Work will focus on 

expanding efforts in tobacco-free living, active living and healthy eating, and quality 

clinical and other preventative services. Funding – $499,588

V. Tribal Delegation Meetings 

Government-to-Government Consultation with the Tohono O’odham Nation

The Tohono O’odham Nation requested formal consultation regarding the CDC/ATSDR Tribal 

Consultation Policy. Consultation was held on December 5, 2012, via conference call. 

Participants included Dr. Ned Norris (Chairman, Tohono O’odham Nation), Chester Antone 

(Councilman, Tohono O’odham Nation), Ms. Teresa Zhang (Assistant Legislative Attorney, 

Tohono O’odham Nation), and Ms. Marcilda Geronimo (Legislative Secretary’s Office, Tohono 

O’odham Nation), Dr. Thomas Frieden (Director, CDC, and Administrator, ATSDR), Dr. Judith 

Monroe (Deputy Director, CDC, and Director, OSTLTS), Ms. Delight Satter (Associate Director 

for Tribal Support, OSTLTS), and Ms. Kimberly Cantrell (Deputy Associate Director for Tribal 

Support, OSTLTS).The Tohono O’odham Nation delegation discussed the Tribal Consultation 

Policy with Dr. Frieden and urged him to move forward on finalizing the revised Policy to 

ensure a current Policy in place at CDC/ATSDR (the previous Policy expired in 2010). 

Oklahoma City Area Inter-Tribal Health Board Meeting 

On July 11, 2013, Dr. Thomas Frieden (Director, CDC, and Administrator, ATSDR) attended a 

meeting of the Oklahoma City Area Inter-Tribal Health Board in Oklahoma City, Oklahoma. 

VI. Agency Tribal Advisory Committee 
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FY 2013 HHS Tribal Consultation Report 

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

The CDC/ATSDR Tribal Advisory Committee (TAC) serves as an advisory committee to 

CDC/ATSDR providing input, guidance, and advice on policies, guidelines, and programmatic 

issues affecting the health of Indian tribes. The TAC is composed of 16 members: one delegate 

from a federally recognized tribe in each of the 12 IHS areas, and one delegate from four 

federally recognized tribes at-large. A current TAC roster is available at the following website: 

http://www.cdc.gov/tribal/tac/index.html. 

In FY 2013, the TAC convened at CDC Headquarters in Atlanta, Georgia, on February 5–7, 

2013. Discussion topics included the Tribal Consultation Policy, tribal public health success 

stories, grant information, opportunities at CDC for Native participation, community-based 

participatory public health, substance abuse and mental health, diabetes, worker safety, and 

health outreach. The session also included a roundtable discussion with CDC/ATSDR senior 

leadership. In FY 2014, CDC will update the TAC Charter (finalized on November 21, 2013) 

and conduct recruitment for the open delegate positions on the TAC. The winter 2014 TAC

Meeting and 10th Biannual Tribal Consultation Session will be held in Atlanta, Georgia, on 

February 18–19, 2014. 

VII. Agency Tribal Consultation Policy 

The CDC/ATSDR Tribal Consultation Policy requires that all agency programs consult with 

tribal governments when developing programs, policies, and activities that will affect Native 

populations. The goal of the Policy includes, but is not limited to, assisting in eliminating the 

health disparities faced by Indian tribes, ensuring that access to critical health and human 

services and public health services is maximized to advance or enhance the social, physical, and 

economic status of Indians; and promoting health equity for all Indian people and communities. 

The government-to-government relationship between the US and federally recognized Indian 

tribes dictates that the principal focus for consultation by CDC is with Indian tribes, individually 

or collectively. Consultation parties include: Indian tribes represented by the tribal president, 

tribal chair, or tribal governor, or an elected or appointed tribal leader, or their authorized 

representative; and the CDC director, ATSDR administrator, CDC deputy director for State, 

Tribal, Local and Territorial Support, or their designee. 

CDC/ATSDR may gather information from Indian organizations in accordance with the Federal 

Advisory Committee Act (FACA), 5 U.S.C. App. 2, or with the “Unfunded Mandates Reform 

Act Exemption” to FACA found in the Unfunded Mandates Reform Act, P.L. 104-4, Section 

204. The government does not participate in government-to- government consultation with these 

entities; rather the government communicates with these organizations in the interests of Indian 

tribes and Indian people. CDC may also communicate with Native-serving organizations, 

including urban and rural Indian organizations, in the interests of Indian communities and Indian 

people. Government-to-government consultation at CDC will occur as outlined in the HHS 

Tribal Consultation Policy. 

The policy was signed on October 18, 2005, and updated on November 12, 2013 (FY 2014). A 

copy of the updated policy can be found at the following website: 

www.cdc.gov/tribal/documents/tac/2014/CDCATSDR_Tribal_Consultation_Policy.pdf
Acronym List

FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

Acronym List

AAIP Association of American Indian Physicians

AASTEC Albuquerque Area Southwest Tribal Epidemiology Center

AEHAP Association of Environmental Health Academic Programs

AI/AN American Indian/Alaska Native

AIDS Acquired Immunodeficiency Syndrome

AIP Arctic Investigations Program

ALS Amyotrophic lateral sclerosis

ANTHC Alaska Native Tribal Health Consortium 

APHA American Public Health Association

ATSDR Agency for Toxic Substances and Disease Registry

BPA Bisphenol A

BRFSS Behavioral Risk Factor Surveillance System

CBA Capacity Building Assistance

CCPP Catawba Cultural Preservation Project

CDC Centers for Disease Control and Prevention

CN Cherokee Nation

CRC Colorectal Cancer

CRCCP Colorectal Cancer Control Program

CRST Cheyenne River Sioux Tribe

CSELS Center for Surveillance, Epidemiology and Laboratory Services

CTG Community Transformation Grant

CTSI Confederated Tribes of Siletz Indians

DBDDD Division of Birth Defects and Developmental Disabilities

DCH Division of Community Health

DCPC Division of Cancer Prevention and Control

DDT Division of Diabetes Translation

DEEHS Division of Emergency and Environmental Health Services

DHAP Division of HIV/AIDS Prevention

DHCPP Division of High-Consequence Pathogens and Pathology

DHDD Division of Human Development and Disability

DHDSP Division of Heart Disease and Stroke Prevention

DLPSS Division of Laboratory Programs, Standards and Services

DLS Division of Laboratory Sciences

DOH Division of Oral Health

DPEI Division of Preparedness and Emerging Infections

DPH Division of Population Health

DPHPI Division of Public Health Performance Improvement

DRH Division of Reproductive Health
Acronym List

FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

DSEPD Division of Scientific Education and Professional Development 

DSNS Division of Strategic National Stockpile

DSTDP Division of STD Prevention

DTHHS Division of Toxicology and Human Health Sciences

DUIP Division of Unintentional Injury Prevention

DVBD Division of Vector Borne Diseases

EHAC National Environmental Health Science and Protection Accreditation Council

EHSB Environmental Health Services Branch

EIS Epidemic Intelligence Service

EMS Emergency Medical Services

ERNEH Empowering Ramah Navajos to Eat Healthy

FACA Federal Advisory Committee Act

FBI Federal Bureau of Investigation

FDA Food and Drug Administration

FSO Field Services Office

FY Fiscal Year

GLITC Great Lakes Inter Tribal Council

GPRA Government Performance and Results Act

GRIC Gila River Indian Community

GYT Get Yourself Tested

HA2020 Health Alaskans 2020

HHS Department of Health and Human Services 

HICSB HIV Incidence and Case Surveillance Branch

HIV Human Immunodeficiency Virus 

HPV Human Papillomavirus

HRSA Health Resources and Services Administration

iGAS Invasive Group A Streptococcus

IHS Indian Health Service 

IOBUSD Indian-Oasis Baboquivari Unified School District 

IPM Integrated Pest Management

LHI Leading Health Indicator

MAD Mass Antibiotic Distribution

MCH Maternal and Child Health

MCHEP Maternal and Child Health Epidemiology Program

MCN Muscogee Creek Nation

MCV Molluscum Contagiosum Virus

MLBO Mille Lacs Band of Ojibwe

MWTLC Montana Wyoming Tribal Leaders Council

NARCH Native American Research Center for Health

NCBDDD National Center on Birth Defects and Developmental Disabilities 
Acronym List

FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

NCCDPHP National Center for Chronic Disease Prevention and Health Promotion 

NCEH National Center for Environmental Health 

NCEZID National Center for Emerging and Zoonotic Infectious Diseases 

NCHHSTP National Center for HIV, Viral Hepatitis, STD and Tuberculosis Prevention 

NCIPC National Center for Injury Prevention and Control 

NCIRD National Center for Immunization and Respiratory Diseases

NDW National Data Warehouse

NEC Navajo Epidemiology Center

NIOSH National Institute of Occupational Safety and Health

NN Navajo Nation

NNDOH Navajo Nation Division of Health

NNOSHA Navajo Nation Occupational Safety and Health Administration

NNAAPC National Native American AIDS Prevention Center

NOFAS National Organization on Fetal Alcohol Syndrome

NPAIHB Northwest Portland Area Indian Health Board

NPHII National Public Health Improvement Initiative

NPIRS National Patient Information Reporting System

NPTTTAC Northern Plains Tribal Tobacco Technical Assistance Center

NWTEC Northwest Tribal Epidemiology Center 

OD Office of the Director

OPHPR Office of Public Health Preparedness and Response

OSH Office on Smoking and Health

OSTLTS Office for State, Tribal, Local and Territorial Support

OTA Office of Tribal Affairs (NCEH/ATSDR)

PCV Pneumococcal Conjugate Vaccine 

PHA Public Health Advisor

PHAB Public Health Accreditation Board

PHAP Public Health Associate Program

PHLP Public Health Law Program

PHHS Preventive Health and Health Services

PIMC Phoenix Indian Medical Center 

PRAMS Pregnancy Risk Assessment and Monitoring System

PRC Paralysis Research Center

PTC Prevention Training Center

RMSF Rocky Mountain Spotted Fever

RTHP Return to a Healthy Past

RZB Rickettsial Zoonoses Branch

SCF Southcentral Foundation 

SEARHC Southeast Alaska Regional Health Consortium

SKC Salish Kootenai College
Acronym List

FY 2013 HHS Tribal Consultation Report

Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)

SSM Sault Ste. Marie Tribe of Chippewa Indians

STD Sexually Transmitted Infection / Sexually Transmitted Disease

TAC Tribal Advisory Committee

TCC Tanana Chiefs Conference

TCU Tribal Colleges and Universities

TIHP Toiyabe Indian Health Project

TOHOHI Tohono O’odham Heritage of Health Initiative

TPP Tobacco Prevention Program

UNM University of New Mexico

USDA US Department of Agriculture

WISEWOMAN Well-Integrated Screening/Evaluation for Women across the Nation

YKHC Yukon Kuskokwim Health Corporation

Y.O.U.T.H. Young O’odham United Through Health (Y.O.U.T.H.)